2nd International Consensus Conference on Duodenal Switch

Thursday Pre-Conference Workshop

English (en anglais) view flipbook / view PDF
French (en français) view flipbook / view PDF

   Friday Pre-Conference Workshop  

Thursday, May 18, 2017

Time
Activity
07:00 - 08:00 REGISTRATION OPEN
07:00 - 08:00 BREAKFAST
08:00 WELCOME
Speakers: Drs. Michel Gagner and Laurent Biertho
08:00 - 09:45 NUTRITION, PHYSIOLOGY OF MALABSORPTION, HORMONAL ASPECTS
Moderators: Drs. Laurent Biertho, Jean Gugenheim
Details

Jean Gugenheim, MD

Dr. Jean Gugenheim is professor of Digestive Surgery at the University of Nice-Sophia Antipolis since 1991.
 
He is Head of the Department of Digestive Surgery in University Hospital of Nice since 2001.
 
He develops liver surgery and bariatric surgery. He is President of The French Society of Obesity Surgery.
 
His research interests include liver morbidities related to obesity, bariatric surgery for obese patients with kidney disease, organic lipophiles pollutants and metabolic syndrome.
08:00 - 08:20 Introducing Duodenal Switch In Your Practice
Speaker: Dr. Vivek Prachand
Details

Vivek N. Prachand, MD FACS
Associate Professor, Section of General Surgery
Director of Minimally Invasive Surgery
Chief Quality Officer, Department of Surgery
Executive Medical Director for Procedural Quality and Safety
University of Chicago Medicine & Biological Sciences

A Chicago native, Dr. Prachand pursued his undergraduate studies and medical school education at Northwestern University. After completing his surgical training at Barnes Hospital, Washington University School of Medicine in St. Louis, Missouri and a fellowship at the Glasgow Royal Infirmary in 2001, he joined the faculty at the University of Chicago where he is Associate Professor of Surgery. In addition to being the Director of Minimally Invasive Surgery, Dr. Prachand's clinical interest is in the application of minimally invasive techniques for the treatment of severe obesity, gastrointestinal tumors of the foregut and surgical disorders of the hiatus and spleen. In 2002, he was the first surgeon in the Midwestern U.S. to perform a totally laparoscopic biliopancreatic diversion with duodenal switch, and has been performing laparoscopic-thoracoscopic esophagectomy for over a decade. In addition to his clinical responsibilities, Dr. Prachand is the Chief Quality Officer for the Department of Surgery, and serves as the Executive medical Director for Procedural Quality and Patient Safety for University of Chicago Medicine and Biological Sciences.
08:20 - 08:40 Pre-Operative Assessment
Speaker: Dr. Ara Keshishian
Details

Ara Keshishian, MD, FACS, FASMBS
 

Bio coming soon.

08:40 - 09:00 SADI, SIPS or Standard DS: How to choose?
Speaker: Dr. Jacques Himpens
Details

Jacques Himpens
The European School of laparoscopic surgery
St Blasius general Hospital Dendermonde and St Pierre University Hospital Brussels, Belgium

Jacques Himpens, MD, PhD, graduated from Leuven University (1977), is an Associate Professor of surgery at the Université Libre de Bruxelles and Chief of Bariatric/Metabolic Surgery at the CHIREC hospital, Brussels, and the St. Blasius Hospital, Dendermonde, Belgium. He is president-elect (2017-2018) of IFSO.

Special achievements include: the world's first "robotic" procedure with the Intuitive Surgery "Mona" prototype (1997), the first laparoscopic gastric bypass in Belgium (1999), the first laparoscopic sleeve gastrectomy, the first biliopancreatic diversion with duodenal switch (2001).

He is a prolific author, is co-editor for the "Obesity Surgery" journal and member of the editorial board of "SOARD".

Presentation Overview:

The SADI/SIPS procedure is a simplified version of the classic Biliopancreatic Diversion by Duodenal Switch and Sleeve Gastrectomy (DS). The difference merely resides at the duodeno-jejunal anastomosis: a Roux limb for the DS procedure, versus a Billroth II construction for the SADI/SIPS. The advocates of the SADI/SIPS claim a reduced risk of postoperative obstruction by internal hernia despite a policy of non-closure of Petersen space. The difference in duodenal anastomosis implies a more dangerous situation in case of leak for the Billroth II type of procedure, because the duodeno-ileal loop anastomosis precludes the use of stents. The Roux en Y construction causes different physiologic responses in terms of glucose absorption, which may result in enhanced activity on type 2 diabetes mellitus compared to the SADI/SIPS. In case of protein malnutrition or excessive weight loss, the limb lengths can be altered in both types of procedures, but changes may be finer tuneable with the DS.

In conclusion, both procedures have their pros and cons. Randomized prospective clinical studies are mandatory.

09:00 - 09:20 The Role of Limb Length on Absorption and Side Effects
Speaker: Dr. Simon Marceau
09:20 - 09:40 Physiological Effects of DS
Speaker: Dr. Ranjan Sudan
09:40 - 09:50 Discussion
09:50 - 10:15 NUTRITION BREAK
10:15-12:30 OUTCOMES, RESULTS
Moderators: Drs. Philippe Topart, Muhammad Jawad
Details

Phillippe Topart, MD

Dr. Philippe Topart, MD, graduated from Brest University, France in 1992. After serving as assistant professor of surgery and consultant surgeon there, he moved to private practice. He is part of six (6) associates at clinique de l’Anjou, Angers, France. Dr. Topart devotes his activity exclusively to bariatric surgery. He and one of his associates perform 400+ laparoscopic procedures a year. His practice includes sleeve gastrectomy, gastric bypass and transit bipartition and he has been performing biliopancreatic surgery for 15 years with a significant number of conversions from other bariatric procedures. Dr. Topart is a member of the French Academy of Surgery and of the editorial boards of the journals Obesity Surgery and Surgery of Obesity and Related Diseases.
10:15-10:30 Long-Term Results of DS
Speaker: Dr. Simon Biron
Details

Dr. Simon Biron

Bio coming soon.

10:30-10:45 Outcomes of Single-Anastomosis DS (SADI)
Speaker: Dr. Antonio Torres
10:45-11:00 Current Outcomes of SIPS
Speaker: Dr. Mitchell Roslin
11:00-11:15 DS in Super-Obese Patient: Outcome and Staged Option
Speaker: Dr. Jean Gugenheim
Details

Jean Gugenheim, MD

Dr. Jean Gugenheim is professor of Digestive Surgery at the University of Nice-Sophia Antipolis since 1991.
 
He is Head of the Department of Digestive Surgery in University Hospital of Nice since 2001.
 
He develops liver surgery and bariatric surgery. He is President of The French Society of Obesity Surgery.
 
His research interests include liver morbidities related to obesity, bariatric surgery for obese patients with kidney disease, organic lipophiles pollutants and metabolic syndrome.
11:15-11:30 SIPS As A Second Stage Surgery
Speaker: Dr. Mitchell Roslin
11:30-11:45 Comparative Evaluation of Two Types of Biliopancreatic Diversion (SADI vs. Switch)
Speaker: Dr. Yury Yashkov
Details

Dr. Yury Yashkov

Yury Yashkov was born in 1957 in Moscow. In 1980 he has graduated 1-st Moscow Medical Institute.  1980-1982 - specialized in general surgery in The Russian Research Center of Surgery where he worked till 2002. Since 1991 Dr. Yashkov has been working as a bariatric surgeon, in 1999 first in Russia he proposed a concept of Surgical treatment for Diabetes Mellitus type 2. Since 2003 he’s been working as a head of Obesity Surgery Service in The Center of Endosurgery and Lithotripsy in Moscow - European Center of Excellence in Bariatric and metabolic surgery. Since 2016 he works also in The Center of Obstetrics, Gynecology and Perinatology (Bariatric Surgery Dep) as a leading Consultant for Bariatric Surgery.

Doctor of the Medical Sciences (PhD) since 1999.     

Dr. Yashkov is an author of about 300 publications and more than 250 presentations mainly in the field of bariatric and metabolic surgery

  • Member of IFSO General Counsil (International Federation for the Surgery of Obesity and Metabolic Disorders), Member of European Accreditation Counsil for Bariatric Surgery (EAC-BS)
  • A founder and a President of The Society of Bariatric surgeons of Russia since 2000.
  • President of The International Federation of the Surgery of Obesity   - European Chapter (IFSO-EC) for the period 2012-2014.
  • President of Moscow International Bariatric Congress in April 2016. Co-President of The 1-st European Obesity Summit (EOS) on June 1-4, 2016 in Gothensburg (Sweden). 
  • Member of the Editorial Board of journals:  Obesity Surgery (International) and Obesity and Metabolism (Russia).
11:45-12:00 DS in Insulin Requiring Patients
Speaker: Dr. Ranjan Sudan
12:00-12:15 100 Consecutive SADS. Outcomes
Speaker: Dr. Mahir Ozmen
12:15-12:30 Discussion
12:30-13:30 LUNCH
13:30-14:30 MANAGEMENT OF SIDE EFFECTS AND COMPLICATIONS
Moderators: Drs. Simon Marceau, Vivek Prachand
Details

Vivek N. Prachand, MD FACS
Associate Professor, Section of General Surgery
Director of Minimally Invasive Surgery
Chief Quality Officer, Department of Surgery
Executive Medical Director for Procedural Quality and Safety
University of Chicago Medicine & Biological Sciences

A Chicago native, Dr. Prachand pursued his undergraduate studies and medical school education at Northwestern University. After completing his surgical training at Barnes Hospital, Washington University School of Medicine in St. Louis, Missouri and a fellowship at the Glasgow Royal Infirmary in 2001, he joined the faculty at the University of Chicago where he is Associate Professor of Surgery. In addition to being the Director of Minimally Invasive Surgery, Dr. Prachand's clinical interest is in the application of minimally invasive techniques for the treatment of severe obesity, gastrointestinal tumors of the foregut and surgical disorders of the hiatus and spleen. In 2002, he was the first surgeon in the Midwestern U.S. to perform a totally laparoscopic biliopancreatic diversion with duodenal switch, and has been performing laparoscopic-thoracoscopic esophagectomy for over a decade. In addition to his clinical responsibilities, Dr. Prachand is the Chief Quality Officer for the Department of Surgery, and serves as the Executive medical Director for Procedural Quality and Patient Safety for University of Chicago Medicine and Biological Sciences.
13:30-13:45 Management of Duodenal Leaks
Speaker: Dr. Pierre Garneau
13:45-14:00 Management of Intestinal Obstruction
Speaker: Dr. Jacques Himpens
Details

Jacques Himpens
The European School of laparoscopic surgery
St Blasius general Hospital Dendermonde and St Pierre University Hospital Brussels, Belgium

Jacques Himpens, MD, PhD, graduated from Leuven University (1977), is an Associate Professor of surgery at the Université Libre de Bruxelles and Chief of Bariatric/Metabolic Surgery at the CHIREC hospital, Brussels, and the St. Blasius Hospital, Dendermonde, Belgium. He is president-elect (2017-2018) of IFSO.

Special achievements include: the world's first "robotic" procedure with the Intuitive Surgery "Mona" prototype (1997), the first laparoscopic gastric bypass in Belgium (1999), the first laparoscopic sleeve gastrectomy, the first biliopancreatic diversion with duodenal switch (2001).

He is a prolific author, is co-editor for the "Obesity Surgery" journal and member of the editorial board of "SOARD".

Presentation Overview:

Intestinal obstruction is one of the most dreaded complications after bariatric/metabolic procedures, and DS is no exception. Obstructions can occur early (i.e. within 30 days postoperatively) or late. Because in the patient with obesity symptoms may be less obvious than in normal weight individuals, the threshold for intervening surgically should be low, because obstruction may affect the bypassed part of the intestine hence cause a “blow-out”. Blow-out may be a bigger threat than with gastric bypass because the blind ending segment is the duodenum, which is a much less compliant structure than the stomach.

Concerning the cause of the obstruction after DS, several conditions exist: adhesions, abdominal wall hernias including trocar hernias, rare causes such as bezoar, and, finally and importantly, internal hernias. Concerning the latter, careful closure of Petersen’s and of the mesenteric defect at the jejuno-ileal anastomosis are of the utmost importance to prevent this potentially lethal complication.

14:00-14:15 Management of Choledocholithiasis
Speaker: Dr. Muhammad Jawad
14:15-14:30 Management of Protein Malnutrition
Speaker: Dr. Olivier Court
14:30-14:45 NUTRITION BREAK
14:45-16:30 CONVERSION: WHEN, WHY AND HOW?
Moderators: Drs. Mehran Anvari, Ara Keshishian
14:45-15:00 Band to DS
Speaker: Dr. Simon Marceau
15:00-15:15 DS Conversion of Gastric Bypass to DS
Speaker: Dr. Ara Keshishian
15:15-15:30 DS for Revision of Failed SG
Speaker: Dr. Laurent Biertho
15:30-15:45 SADI for Revision of Failed SG
Speaker: Dr. Antonio Torres
15:45-16:00 Revision for Malnutrition or Side Effects: When and how? 
Speaker: Dr. Philippe Topart
Details

Phillippe Topart, MD

Dr. Philippe Topart, MD, graduated from Brest University, France in 1992. After serving as assistant professor of surgery and consultant surgeon there, he moved to private practice. He is part of six (6) associates at clinique de l’Anjou, Angers, France. Dr. Topart devotes his activity exclusively to bariatric surgery. He and one of his associates perform 400+ laparoscopic procedures a year. His practice includes sleeve gastrectomy, gastric bypass and transit bipartition and he has been performing biliopancreatic surgery for 15 years with a significant number of conversions from other bariatric procedures. Dr. Topart is a member of the French Academy of Surgery and of the editorial boards of the journals Obesity Surgery and Surgery of Obesity and Related Diseases.

Presentation Overview:

Biliopancreatic diversion is a powerful weight loss procedure which allows for a 75% excess weight loss and control of comorbidities on the long term. Revision rates for excessive malabsorption ranges from 0.5 to 4.9% and 3 to 18.5% after BPD/DS and BPD respectively. Revisions increase common channel by up to 150 cm. Reversal is necessary in 0.2 to 7% of cases with an increased risk when the common channel is ≤ 50 cm. In most instances, reversal (of the malabsorptive component only) is indicated after the revision failure. Indication for revision of the alimentary and common channels length is essentially based on albumin and prealbumin levels. Although there is no clear definition of malnutrition revision must be discussed when serum albumin and prealbumin levels are <30 g/L and <0.20 g/L  respectively. In most instances these biological abnormalities are associated with multiple vitamin and micronutrient deficiencies. Clinically a % of excess weight loss ≥ 100% represents a major risk of malnutrition. Additional signs are an ongoing weight loss as well as limb oedema (Kwashiorkor). Although low levels of serum albumin and prealbumin (between 30 and 35 g/L and 0.15 and 0.20 g/L) could be regarded as normal during the first year after surgery, stabilization of the weight loss with a return to close to normal values are expected between 12 and 18 after surgery. A proximal, side- to-side anastomosis between the biliopancreatic and alimentary limbs is the preferred option. Most reoperations are performed within 2 years of the initial procedure and for protein malnutrition in about half of the cases. Other indications are based on excessive digestive side effects (diarrhea).

Biliopancreatic diversion can be relatively easily revised to control excessive side effects and protein malnutrition. In several cases, depending on the severity of the malnutrition, a prior feeding jejunostomy can be required rather than other methods of renutrition (TPN, nasogastric feeding tube) which are often not as effective. Altough techically easy to perform the revision in malnourished patients carries the risk of postoperative leakage with devastating consequences and a correct nutritional status must be obtained before revisional surgery. After biliopancreatic diversion, close monitoring must be observed with regular blood checks every 3 months at least within 2 years of the initial procedure to diagnose malnutrition early and avoid liver failure. Blood checks should be repeated every year to ensure a proper nutritional status as the risks may be encountered on the long term although this is relatively rare.

At the end of this presentation, participants should be able to define an adequate biological as well as clinical monitoring program and identify the need to revise biliopancreatic diversion. 

16:00-16:15 Revision for Insufficient Weight Loss (Re-Sleeve): Is it worth it?
Speaker: Dr. Dennis Hong
Details

Dennis Hong MD, MSc, FRCS(C), FACS 
ICES Adjunct Scientist
Associate Professor, McMaster University
Associate Director, Centre for Minimal Access Surgery

Dr. Dennis Hong is an Associate Professor in the Department of Surgery at McMaster University. He specializes in Minimally Invasive and Bariatric Surgery. He completed his undergraduate studies in Biology from the University of Western Ontario in 1992. Dr. Hong received his medical degree (M.D.) from the University of Toronto in 1996. He completed his residency in the Department of Surgery, McMaster University Medical Centre in Hamilton, ON. Then in 2003, he completed a Minimally Invasive Surgery Fellowship at the Legacy Health System in Portland, Oregon, U.S.A.. He joined the Department of Surgery at McMaster University in 2010.

16:15 - 16:30 Discussion
16:30 -17:00 2nd DS CONSENSUS STATEMENT
Speaker: Dr. Michel Gagner
17:00 - 17:05 Adjournment
17:05 - 19:00 Meet the Faculty Wine & Cheese Reception

Friday, May 19, 2017

Time
Activity
07:00 REGISTRATION OPEN
07:00 - 08:00 BREAKFAST
08:00 - 12:00 LIVE SURGERY
Expert Panel: Drs. Jean Gugenheim, Rajan Sudan, Antonio Torres
Details

Jean Gugenheim, MD

Dr. Jean Gugenheim is professor of Digestive Surgery at the University of Nice-Sophia Antipolis since 1991.
 
He is Head of the Department of Digestive Surgery in University Hospital of Nice since 2001.
 
He develops liver surgery and bariatric surgery. He is President of The French Society of Obesity Surgery.
 
His research interests include liver morbidities related to obesity, bariatric surgery for obese patients with kidney disease, organic lipophiles pollutants and metabolic syndrome.
Live Surgery 1: Single Anastomosis Duodeno-­Ileostomy (SADI)
Operator: Dr. Andres Sanchez-­Pernaute, Madrid, Spain
Live Surgery 2: SASI bypass (Single Anastomosis Sleeve Ileal)
Operator: Dr. Tarek Mahdy, Sharjah, UAE
Live Surgery 3: Biliopancreatic Diversion with Duodenal Swich (BPD-DS)
Operator: Dr. Giovanni Dapri, Brussels, Belgium
Details

Giovanni DAPRI, MD, PhD, FACS, FASMBS, HonFPALES, HonSPCMIN, HonBSS, HonCBCD
Professor of Surgery
Department of Gastrointestinal Surgery
European School of Laparoscopic Surgery

Giovanni Dapri is Professor of Surgery at the Department of Gastrointestinal Surgery, Saint-Pierre University Hospital, Brussels (Belgium). He is Professor of Anatomy at University of Mons (Belgium). In his career, he has edited 5 books, published more than 110 scientific articles and more than 50 chapters in other books. He invented in 2008 an instrument set to operate in Single Incision Laparoscopy. He has performed more than 90 laparoscopic procedures in front of the audience in foreign countries.
Live Surgery 4: Re-Sleeve Gastrectomy
Operator: Dr. Dennis Hong, Hamilton, ON
Details

Dennis Hong MD, MSc, FRCS(C), FACS 
ICES Adjunct Scientist
Associate Professor, McMaster University
Associate Director, Centre for Minimal Access Surgery

Dr. Dennis Hong is an Associate Professor in the Department of Surgery at McMaster University. He specializes in Minimally Invasive and Bariatric Surgery. He completed his undergraduate studies in Biology from the University of Western Ontario in 1992. Dr. Hong received his medical degree (M.D.) from the University of Toronto in 1996. He completed his residency in the Department of Surgery, McMaster University Medical Centre in Hamilton, ON. Then in 2003, he completed a Minimally Invasive Surgery Fellowship at the Legacy Health System in Portland, Oregon, U.S.A.. He joined the Department of Surgery at McMaster University in 2010.

Live Surgery 5: Conversion of Sleeve to SADI
Operator: Dr. Andres Sanchez-Pernaute, Madrid, Spain
Live Surgery 6: Conversion of Sleeve to SIPS
Operator: Dr. Mitchell Roslin, New York City, USA
Live Surgery 7: Robotic Assisted Duodenal Switch
Operator: Dr. Andre Teixeira, Orlando, FL, USA
Live Surgery 8: Stomach Intestinal Sparing Surgery (SIPS)
Operator: Dr. Daniel Cottam, Salt Lake City, UT, USA
12:00 - 13:30 LUNCH
13:30 - 15:00 EDITED VIDEOS FROM FACULTY: TIPS AND TRICKS
Moderators: Drs. Pierre Garneau, Olivier Court
13:30 - 13:38 Duodenal Dissection: Inferior versus Posterior Approach
Speaker: Dr. François Julien
Details

Dr. Francois Julien 
General and Bariatric Surgeon
Quebec City Heart and Lung Institute

Dr Francois Julien is a general and bariatric surgeon at the Quebec city Heart and Lung Institute.  He attended medical school at Université de Montréal and trained in general surgery at Université Laval, in Quebec City.  He pursued a minimally invasive and bariatric fellowship at the University of Ottawa and Université Laval

13:38 - 13:46 Intra-Operative Complications
Speaker: Dr. Ara Keshishian
13:46 - 13:54 Management of Duodenal Leak
Speaker: Dr. Ranjan Sudan
13:54 - 14:02 Mesenteric Defects Closure
Speaker: Dr. Jean Gugenheim
Details

Jean Gugenheim, MD

Dr. Jean Gugenheim is professor of Digestive Surgery at the University of Nice-Sophia Antipolis since 1991.
 
He is Head of the Department of Digestive Surgery in University Hospital of Nice since 2001.
 
He develops liver surgery and bariatric surgery. He is President of The French Society of Obesity Surgery.
 
His research interests include liver morbidities related to obesity, bariatric surgery for obese patients with kidney disease, organic lipophiles pollutants and metabolic syndrome.
14:02 - 14:10 Management of Intra-Operative Bleeding
Speaker: Dr. Vivek Prachand
Details

Vivek N. Prachand, MD FACS
Associate Professor, Section of General Surgery
Director of Minimally Invasive Surgery
Chief Quality Officer, Department of Surgery
Executive Medical Director for Procedural Quality and Safety
University of Chicago Medicine & Biological Sciences

A Chicago native, Dr. Prachand pursued his undergraduate studies and medical school education at Northwestern University. After completing his surgical training at Barnes Hospital, Washington University School of Medicine in St. Louis, Missouri and a fellowship at the Glasgow Royal Infirmary in 2001, he joined the faculty at the University of Chicago where he is Associate Professor of Surgery. In addition to being the Director of Minimally Invasive Surgery, Dr. Prachand's clinical interest is in the application of minimally invasive techniques for the treatment of severe obesity, gastrointestinal tumors of the foregut and surgical disorders of the hiatus and spleen. In 2002, he was the first surgeon in the Midwestern U.S. to perform a totally laparoscopic biliopancreatic diversion with duodenal switch, and has been performing laparoscopic-thoracoscopic esophagectomy for over a decade. In addition to his clinical responsibilities, Dr. Prachand is the Chief Quality Officer for the Department of Surgery, and serves as the Executive medical Director for Procedural Quality and Patient Safety for University of Chicago Medicine and Biological Sciences.
14:10 - 14:18 SADS to Conventional DS for Bile Reflux
Speaker: Dr. Muhammad Jawad
14:18 - 14:26 DS After Banding:  Tips and Tricks and Result on 38 Patients
Speaker: Dr. Daniel Krawczykowski
14:26 - 14:34 Special Interesting Cases
Speaker: Dr. Jacques Himpens
Details

Jacques Himpens
The European School of laparoscopic surgery
St Blasius general Hospital Dendermonde and St Pierre University Hospital Brussels, Belgium

Jacques Himpens, MD, PhD, graduated from Leuven University (1977), is an Associate Professor of surgery at the Université Libre de Bruxelles and Chief of Bariatric/Metabolic Surgery at the CHIREC hospital, Brussels, and the St. Blasius Hospital, Dendermonde, Belgium. He is president-elect (2017-2018) of IFSO.

Special achievements include: the world's first "robotic" procedure with the Intuitive Surgery "Mona" prototype (1997), the first laparoscopic gastric bypass in Belgium (1999), the first laparoscopic sleeve gastrectomy, the first biliopancreatic diversion with duodenal switch (2001).

He is a prolific author, is co-editor for the "Obesity Surgery" journal and member of the editorial board of "SOARD".

14:34 - 14:42 Revisions for Malnutrition Post SADI
Speaker: Dr. Antonio Torres
14:42 - 14:50 Tricks in Staged Procedures
Speaker: Dr. Philippe Topart
Details

Phillippe Topart, MD

Dr. Philippe Topart, MD, graduated from Brest University, France in 1992. After serving as assistant professor of surgery and consultant surgeon there, he moved to private practice. He is part of six (6) associates at clinique de l’Anjou, Angers, France. Dr. Topart devotes his activity exclusively to bariatric surgery. He and one of his associates perform 400+ laparoscopic procedures a year. His practice includes sleeve gastrectomy, gastric bypass and transit bipartition and he has been performing biliopancreatic surgery for 15 years with a significant number of conversions from other bariatric procedures. Dr. Topart is a member of the French Academy of Surgery and of the editorial boards of the journals Obesity Surgery and Surgery of Obesity and Related Diseases.

Presentation Overview:

Because obesity remains a chronic disease weight loss control remains problematic for some patients on the long term. Insufficient weight loss (percentage of excess weight loss (%EWL) < 50%) is observed in approximately 20% after Roux-en-Y gastric bypass (RYGB). For a number of them other procedures such as gastric banding and sleeve gastrectomy have already been performed before gastric bypass. Surgical revision can be performed by various procedures including malabsorptive techniques. Conversion to a biliopancreatic diversion with duodenal switch (BPD/DS) remains a complex technique which could not always be performed as a one-stage procedure when the gastric bypass was fully dismantled and concerted to a regular sleeve gastrectomy before completing the duodenal switch. Based on our experience in 26 patients we designed a technique called “hybrid sleeve”. This approach does not require to alter the gastrojejunal anastomosis of the gastric bypass. Instead, the alimentary limb is divided approximately 5-6 cm distal from the gastrojejunal anastomosis and after resection of the fundus of the gastric remnant this short segment of jejunum is sutured to the antrum. The biliopancreatic diversion with duodenal switch is then completed in an usual fashion with division of the duodenum, measurement of the 250 last centimeters of the ileum and a common channel of 100 cm. Finally, the rest of the alimentary limb of the gastric bypass (jejunum) is abandoned without a full reconstruction and the creation of a “double” Roux limb within this modified duodenal switch. 

At the end of this presentation, participants should be able to simpler and alternative technique to convert staged procedures leading to a gastric bypass into a biliopancretic diversion with duodenal switch in order to restore weight loss.

14:50 - 15:00 SADS with DaVinci Xi
Speaker: Dr. Mahir Ozmen
15:00 - 15:30 Discussion
15:30 - 16:00 BREAK
16:00 - 17:30 Allied Health Nutrition for DS
Moderators: Ms. Stephanie Michon, RD, Stephanie Kirsic, RD
Details

Stephanie Kirsic, M.Sc., RD
Registered Dietitian
Bariatric Surgical Program
St. Joseph's Healthcare Hamilton 

Stephanie Kirsic graduated from The University of Western Ontario in 2008 with a Bachelor of Science degree in Human Ecology (Food & Nutrition). She continued her educational pursuits and completed a combined Master of Science degree in Dietetics / Dietetic Internship program from D’Youville College in 2011, followed by formal membership with the College of Dietitians of Ontario in 2012. 

Stephanie has worked in family health team settings, private consulting, and most notably, as a member of the Bariatric Surgery Program at St. Joseph’s Healthcare Hamilton (Bariatric Centre of Excellence) since 2012.

16:00 - 16:15 Pre-Operative Assessment and Indication
Speaker: Ms. Annick Dallaire, RN
Details

Annick Dallaire RN
Quebec Heart and Lung Institute
Laval University, Quebec City 

Presentation Overview:

Over the last years, types of bariatric surgery have increased and are more accessible to the patient who need it. We know that no surgeries are perfect, they all have their pros and cons. It's also been proved that the preoperative selection, education and preparation of the patient has a major impact on the outcome of the surgery. Therin lies the importance of proposing the BPD-DS to educated and selected patients.

With the experience gained through follow ups of more than 7 000 bariatric patients during the last 30 years as well as 550 bariatric surgeries done each year (including 200 DBP-DS), the IUCPQ's bariatric team has perfected its evaluation criteria and the screening process for BPD-DS preoperative patients.

This session presents the indications for BPD-DS and describes the different criteria and also the exclusion criteria. The key role of each professional in the team for the evaluation of the patient will be described.

16:15 - 16:30 Pre-Operative Nutritional Evaluation
Speaker: Ms. Stephanie Michon, RD
16:30 - 16:45 Diet Recommendations and Follow-Up After DS
Speaker: Ms. Stephanie Kirsic, RD
Details

Stephanie Kirsic, M.Sc., RD
Registered Dietitian
Bariatric Surgical Program
St. Joseph's Healthcare Hamilton 

Stephanie Kirsic graduated from The University of Western Ontario in 2008 with a Bachelor of Science degree in Human Ecology (Food & Nutrition). She continued her educational pursuits and completed a combined Master of Science degree in Dietetics / Dietetic Internship program from D’Youville College in 2011, followed by formal membership with the College of Dietitians of Ontario in 2012. 

Stephanie has worked in family health team settings, private consulting, and most notably, as a member of the Bariatric Surgery Program at St. Joseph’s Healthcare Hamilton (Bariatric Centre of Excellence) since 2012.

Presentation Overview:

Managing adequate nutrition care with the inclusion of a timely follow-up treatment schedule for post-operative duodenal switch patients is crucial to long-term health and wellbeing. This session will focus on nutrition application with an emphasis on energy and macronutrient recommendations, while exploring common nutrition-related obstacles and effective management of potential symptoms.

Learning Objectives:

At the end of this presentation, participants will be able to:

  1. Identify general recommendations for caloric and macronutrient intake following a duodenal switch
  2. Distinguish common nutrition-related risks and side effects, while exploring options for symptom management
  3. Gain insight into development of a practical care plan for adequate long-term nutritional follow-up post duodenal switch
16:45 - 17:15 Management of Vitamin and Mineral Deficiencies
Speaker: Mr. Adam Bryant, RD
Details

Adam Bryant, RD
Registered Dietitian
Bariatric Program
St. Joseph's Healthcare Hamilton 

Adam first graduated from McMaster University with a degree in biology before deciding to pursue a career in nutrition.  He then earned a Bachelor of Applied Science in human nutrition from the University of Guelph.  Adam completed his dietetic internship at Mount Sinai Hospital in Toronto.  During his internship, he spent time learning with the Bariatric Program at Humber River Regional Hospital.  He has worked for the Bariatric Surgery Program at the St. Joseph's Healthcare Hamilton Bariatric Centre of Excellence since 2011.

Presentation Overview:

While all variants of bariatric surgery carry risk for vitamin and mineral deficiencies, the duodenal switch carries the highest overall risk due to the significant malabsorption associated with this surgery.  In order to manage and prevent serious deficiencies, regular supplementation and monitoring is essential.  This presentation will review the current recommendations for micronutrient supplementation, and will review treatment strategies for mild to moderate deficiencies.  Practical considerations for patients will also be reviewed.

Learning Objectives:

At the end of this presentation, participants will be able to:

  1. Identify the specific nutrition risks associated with duodenal switch
  2. Understand routine micronutrient supplementation requirements
  3. Recognize treatment recommendations for mild to moderate deficiencies after duodenal switch
17:15 - 17:30 Management of Protein Deficiencies
Speaker: Ms. Stephanie Michon, RD
17:30 - 17:45 Discussion

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